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2 results

  • Chapter 15 - Tracheal intubation: rigid indirect laryngoscopy

  • from Section 2 - Clinical
  • Edited by Ian Calder, Adrian Pearce
  • Book:
    Core Topics in Airway Management
    Published online:
    10 January 2011
    Print publication:
    16 December 2010, pp 144-150

  • Summary

    This chapter discusses difficult airway, causes of difficulty, patient factors, and types of difficulties. One of the principal difficulties in predicting airway problems under anaesthesia is that in most unexpected cases there are no symptoms. The symptoms associated with obstructed sleep apnoea (OSA) syndrome should be sought in suspected cases. Anaesthetists should be aware of the symptomatology (and signs) of impending airway obstruction. The chapter briefs about special investigations such as 'Quick look' laryngoscopy, ultrasound and radiology. Sleep apnoea patients in particular may well be at greater risk in the postoperative period than at induction, whilst some types of surgery are notorious for engendering airway difficulty post-operatively; facio-maxillary and anterior cervical surgery are examples. Rheumatoid and acromegalic diseases of the larynx are particularly prone to post-extubation obstruction, so that the smallest possible size of tracheal tube should be used.

  • Flexible laryngeal mask as an alternative to reinforced tracheal tube for upper chest, head and neck oncoplastic surgery

  • C. Martin-Castro, A. Montero
  • Journal:
    European Journal of Anaesthesiology / Volume 25 / Issue 4 / April 2008
    Published online by Cambridge University Press:
    01 April 2008, pp. 261-266
    Print publication:
    April 2008
  • Background and objective

    The flexible laryngeal mask airway has been mostly used in spontaneous ventilated children during short procedures to avoid the risk of kinking; little information has been reported about its airway morbidity. The aim of the study was to compare this airway device with the reinforced tracheal tube in mechanically ventilated adult patients.

    Methods

    120 adult patients undergoing general anaesthesia for breast, head and neck oncoplastic surgery, expected to last up to 3 h, were stratified into two airway groups: flexible laryngeal mask airway (n = 60) or reinforced tracheal tube (n = 60). Within each group, patients were randomly allocated to one of the two maintenance anaesthetic subgroups: propofol (n = 30) or sevoflurane (n = 30). Ease of insertion and haemodynamic stress response to placement, ventilation and postoperative morbidity were studied.

    Results

    Easy insertion rate was greater for the flexible laryngeal mask airway (93% vs. 77%, P = 0.01), and the overall success in insertion rate was 100% for both groups. Haemodynamic changes were significantly higher after inserting reinforced tracheal tube (P < 0.001). Oxygen saturation and capnography were comparable in both groups but airway pressure was lower with flexible laryngeal mask airway (P = 0.002). Sore throat, cough and dysphonia were lest frequent with flexible laryngeal mask airway (P < 0.01); also more patients in this group felt comfortable. Sevoflurane gave better results in emergence time, regardless of the airway device used.

    Conclusion

    During anaesthesia in mechanically ventilated adult patients, both devices function adequately, are stable and protect the airway. Flexible laryngeal mask airway results in less postoperative morbidity than reinforced tracheal tube.